Kundra Sandeep, Gupta Vishnu, Bansal Hanish, Grewal Anju, Katyal Sunil, Choudhary Ashwini Kumar
Department of Anesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India.
J Anaesthesiol Clin Pharmacol. 2014 Jan;30(1):46-52. doi: 10.4103/0970-9185.125703.
Epidural application of morphine has been used for postoperative analgesia following spine surgery but short duration of action of single application limits its widespread use.
One hundred and fifty patients undergoing lumbar laminectomy were randomly allocated to two groups of 75 patients each. Anesthetic technique was standardized in both the groups. In Group I, at the completion of laminectomy, a 5 × 1-cm strip of gelfoam soaked in 5 mg morphine (1 mg/ml) was contoured to be placed in the epidural space whereas, in group II, gelfoam soaked in saline was placed in the epidural space and 5 mg morphine (1mg/ml) was instilled over the intact epidural space. Analgesic consumption for 48 hours, time-of first analgesic request, time of ambulation, time of discharge from post anesthesia care unit (PACU) and hospital and adverse effects were recorded. The data was analyzed using appropriate statistical tests.
Mean analgesic consumption in 48 hours was significantly less in group I (8.47 ± 3.674 mg) as compared to group II (24.80 ± 6.009 mg). Supplemental analgesia was requested at 30.03 ± 6.796 hours in Group I, vs 10.25 ± 2.243 in group II (P < 0.001). Group I patients were discharged earlier from PACU as compared to group II (P < 0.001) though time of discharge from hospital was similar in both the groups. There were no major adverse effects except pruritis, which was observed in 30.6% patients in group I and 37.3% in group II (statistically insignificant (P > 0.01)).
Epidural application of morphine soaked in gelfoam is an effective method for prolonging the postoperative analgesia after spine surgery.
吗啡硬膜外给药已用于脊柱手术后的术后镇痛，但单次给药作用时间短限制了其广泛应用。
150例行腰椎椎板切除术的患者被随机分为两组，每组75例。两组麻醉技术均标准化。在第一组中，椎板切除完成后，将一条5×1厘米浸有5毫克吗啡（1毫克/毫升）的明胶海绵塑形后置于硬膜外间隙；而在第二组中，将浸有生理盐水的明胶海绵置于硬膜外间隙，并在完整的硬膜外间隙注入5毫克吗啡（1毫克/毫升）。记录48小时的镇痛药物消耗量、首次镇痛需求时间、下床活动时间、从麻醉后恢复室（PACU）及医院出院的时间以及不良反应。使用适当的统计学检验对数据进行分析。
第一组48小时的平均镇痛药物消耗量（8.47±3.674毫克）显著低于第二组（24.80±6.009毫克）。第一组在30.03±6.796小时需要追加镇痛，而第二组为10.25±2.243小时（P<0.001）。与第二组相比，第一组患者从PACU出院更早（P<0.001），尽管两组的住院出院时间相似。除瘙痒外无重大不良反应，第一组30.6%的患者和第二组37.3%的患者出现瘙痒（无统计学意义（P>0.01））。
硬膜外应用浸有吗啡的明胶海绵是延长脊柱手术后术后镇痛时间的有效方法。
